Last week, the Journal of the American Medical Association (JAMA) published a study looking at the characteristics and comorbidities of 5700 patients hospitalized in New York City with COVID-19. They looked at patients from 12 different hospitals from the period of March 1st-April 4th. The study found that nearly all patients (94%) had at least one chronic disease, most (88%) had more than one- leaving only 6% of those admitted having no underlying conditions. More than half of the patients had high blood pressure, 42% were obese, 19.1% were morbidly obese (BMI>35), and 31% had diabetes.
A New York Times article interviewed Dr. Leora Horwitz, an associate professor at NYU Langone Health, who conducted a similar study. Dr. Horwitz discussed the impact of obesity on COVID-19 mentioning that after age, obesity is the most significant predictor of disease severity. In her study, findings were similar to the one in JAMA but she contextualized these into the role they played in the infected patient. For example- she mentioned the obesity rate outside of the hospital in Long Island is 24% while we can see the hospitalized numbers are almost double. Meaning those who are hospitalized are more obese relative to the rest of the community. Therefore, obesity (most likely through inflammatory processes) may play a role in the body’s ability to handle COVID-19.
Now, it’s important to take a step back and look at these observational studies critically. These were only hospitalized patients; the studies were not looking at patients who were sick and didn’t go to the hospital or those who maybe had the virus and didn’t know. In no way am I saying that if you have impeccable health that you are immune from COVID-19. Nor, am I attempting to blame or shame anyone who is struggling with chronic disease. I know there are many people who are trying their best to get healthier and are following the advice from medical professionals to improve their health.
What I am saying is that clearly there is a very strong correlation with comorbidities and worsening response to COVID-19.
It is not surprising that those who have more chronic health conditions (usually those with advanced age) are more impacted by the virus. This makes logical sense. If your body isn’t functioning at 100% then it will be harder to handle stressors – whether this is an infection or a bout of high exercise intensity. What I find important to highlight is the relationship between environment and lifestyle with emergent medicine.
There is this strange disconnect with the lifestyle choices people make (or are forced into due to their environment) and being sick. We all know we should exercise, eat more vegetables, meditate and drink more water. We know alcohol, fast food and sitting on the couch binging TV shows isn’t great for our health. But when we think about this, we don’t often picture being sick. We just know it’s ‘unhealthy.’ We don’t think about the implications of daily lifestyle choices until the day comes when we are told we’re sick.
I’ve been thinking about the why behind this and I’ve come up with a few ideas.
First, we don’t like to think of being sick. Like really sick. It’s scary and uncomfortable and knowing that there is a possibility of getting sick ourselves is not a thought we like to entertain. We also don’t value our health until we are sick. Therefore, we don’t think of it often. Just like we don’t think about the gas in our car until we’re almost out.
Secondly, the environment in North America continually promotes unhealthy lifestyles. It is just too easy to make unhealthy lifestyle choices. Hyperpalatable, processed foods are everywhere, they are cheap, convenient and addicting. There are countless shows and movies to watch when we feel sad, to escape our problems. We can get everything delivered right to our door, and we know there is a safety net of medications for our ailments- which may be signs our body is giving us that we are getting sicker.
Depending on your race, gender and socioeconomic status there are several barriers to a healthy lifestyle. A Bloomberg article discussing the impact of race and COVID-19 mentioned that “Hispanic people in New York City made up 34% of the deaths while comprising 29% of the population and black people made up 28% of coronavirus deaths while being 22% of the population.” Therefore, there are also factors outside our control which are playing a role in this disconnect.
Another reason I was pondering for this detachment between lifestyle and health is the idea of fat acceptance. We are told that: “It’s okay to be fat.” “People should accept you no matter how you look.” “Eat whatever you want.” “Don’t let anyone tell you how to eat.” Yes, you should not be discriminated against due to how you look, no matter what. In the era of social media and living in a society that judges people on how they appear, it is important to convey the message to people (young and old) that valuing someone based on their appearance is not ethical or intelligent. However, comments like those mentioned above frustrate me because we are missing the point. Yes, it’s okay to be overweight and this shouldn’t impact you in something like a job interview, BUT being overweight does impact your health. We cannot ignore the fact that what we put into our bodies and the decisions we make throughout a day- combined with our environment, make up the health of the body we are living in. We now even know that lifestyle factors can change our genes!
Those are just some of the ideas of barriers I have been thinking about, but obviously there are countless factors impacting the development of chronic disease. There aren’t just a handful of reasons we see such high rates of obesity, diabetes, heart disease and cancer in our population. So, what can we do about this multifaceted issue that affects nearly every person in some way or another?
For starters, we need to understand the implications that our environment and lifestyle have on our health. Not just how we feel at the end of the day or what we look like in the mirror, but on our actual risk of getting sick. We need to acknowledge the connection that diet, exercise, clean air and water have on our health. Then we need to create access to this health for those who don’t have it. This is not an individual change but a societal change. Our food systems need to change. Education around exercise and healthy lifestyle needs to be a priority in our schools. We need to remedy the obesity epidemic, not accept it. These changes can be made. Take smoking for example. Although people still do smoke, there has been a dramatic decrease in smoking since media and governments emphasized the correlation with smoking and getting sick -really sick. Smoking is just one item on a long list of complex factors that play a role in chronic disease- but it shows that when the seriousness of our actions is highlighted – we alter our choices.
So, with the race to find solutions for COVID-19, and assess how we can better protect ourselves from future pandemics- let’s not forget about the role that chronic disease plays. Let’s emphasize the importance of preventative healthcare and lowering our risk for getting sick before it’s too late. Let’s educate and empower each other to make healthier lifestyle choices – not because we want to look or feel better in the moment- but for our health.